Hot topics in pacing therapy

• Published in: Europace
• Main Authors: Platou, E.S., Knutsen, T.M., Steen, T., Kirkfeldt, R., Johansen, J., Nohr, E., Moller, M., Arnsbo, P., Nielsen, J., Pruiti, G.P., Conti, S., Puzzangara, E., Di Grazia, A., Ussia, G.P., Tamburino, C., Calvi, V., Nielsen, J.C., Bloch Thomsen, P.E., Hojberg, S., Riahi, S., Dalsgaard, D., Mortensen, L.S., Andersen, H.R., Kolodzinska, A., Kutarski, A., Grabowski, M., Malecka, B., Jarzyna, I., Opolski, G., Mabo, P., Solnon, A., Tassin, A., Martins, R., Graindorge, L., Cebron, J.P., Rodriguez-Diez, G., Moreno, I., Bello, E., Olmedo, F., Vargas, E., Leal, R., Ortiz, M., Robledo-Nolasco, R., Schau, T., Seifert, M., Meyhoefer, J., Neuss, M., Butter, C., Miyamoto, S.
• Format: Text
• Language: English
• Published: Oxford University Press 2011
• Subjects: Tuesday 28 June 2011; Byrd; Norway; Iceland
• Online Access: http://europace.oxfordjournals.org/cgi/content/short/13/suppl_3/NP-q; https://doi.org/10.1093/europace/eur228

Our centre is serving most of Norway and Iceland for pacemaker and ICD lead extractions. We have adopted a single sheath technique, a variant of the dilating sheath technique described by Byrd. Methods: From 1998 to end of August 2010, we have treated 551 patients, median age 64 years (range 7-95 years), with 904 leads. Fifty-one percent of the extractions were performed on infections, the rest were elective. Median age of all leads was 5 years (range 0,1 to 42 years). The single sheath technique was used in 69% of the extractions, in 26% we used traction alone, in 5% various fishing techniques and in 1% “Evolution” (Cook). We start with a gentle traction and then proceed to single sheath technique after applying a locking stylet (Cook/Spectranetics/VascoMed). A single Cook polypropylene sheath is mounted with a Cook Pin Vise and is gently pushed down the lead with rapid rotation. When serious resistance is met, the sheath size is increased. For larger body leads (ICD) we have also used “VisioSheath” (Spectranetics). In some patients a steel sheath is used to access the subclavian vein. Results: Complete success has been achieved in 96%. Clinical success (ie. removal of all of the lead except the distal 4 cm) has been achieved in 3% of the lead extractions, and. The overall clinical success is 99%. ICD-leads: 154 leads: 99% success, one major complication, resolved without sequela. Median “sheath-time” (ie. the time the sheath is applied) is 5 min., range 1 to 300 minutes. Complications: Major complications 2%, one procedural death, one SCD three weeks after the procedure. Minor complications 1%. Conclusions: The single sheath technique is effective with 99% clinical success. The technique appears to be a quick and effective alternative to laser sheath lead extraction. The complication rate of the single sheath technique is low.